原发性肝癌术后肝功能储备的影响因素

Factors Influencing Hepatic Functional Reserve after Hepatectomy for Primary Liver Cancer

目的探讨原发性肝癌患者肝切除术后影响肝功能储备的因素。方法对行手术切除的272例肝细胞肝癌患者的临床资料进行回顾性分析,观察指标包括:年龄、性别、糖尿病、HBsAg、肿瘤大小、单发/多发、手术切除范围、谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、前白蛋白(PALB)、白蛋白(ALB)、总蛋白(TP)、总胆红素(TB)、直接胆红素(DB)、γ-谷氨酰转肽酶(γ-GT)、胆碱酯酶(CHE)、乳酸脱氢酶(LDH)、总胆汁酸(TBA)、凝血酶原时间(PT)和血小板计数。结果术前高γ-GT是肝功能代偿不全的独立危险因素,ROC曲线显示术前γ-GT预测术后肝功能代偿不全的临界值是168 U.L-1(灵敏度72.7%,特异度90.0%)。当γ-GT≥168 U.L-1时,肝功能代偿不全的发生率为63.6%。结论吲哚氰绿(indocyanine green,ICG)15 min清除率在0%～15%范围内的肝癌患者中,术前γ-GT<168 U.L-1时,术后肝功能恢复良好。因此,术前监测γ-GT水平并结合ICG 15 min清除率可以综合评估患者的肝功能代偿能力。

Objective To investigate the factors influencing hepatic functional reserve after hepatectomy for primary liver cancer. Methods Clinical data of 272 patients who underwent hepatectomy for hepatocellular carcinoma were analyzed retrospectively. Indicators included age, gender, diabetes, HBsAg, tumor size, single/multiple tumor types, extent of surgical resection, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, prealbumin, albumin, total protein＇ total bilirubin, direct bilirubin, γ-glutamyhranspetidase, cholinesterase, lactate dehydrogenase, total bile acid, prothrombin time and platelet count. Results High levels of γ-glutamyltranspetidase were the independent risk factor for decompensation of liver function. ROC curve analysis showed that the cut- off value of preoperative γ-glutamyhranspetidase for predicting postoperative hepatic decompensation was 168 U·L-1（sensitivity：72.7%,specificity： 90.0%）.The incidence of postoperative hepatic decompen- sation was 63.6% when γ-glutamyltranspetidase concentrations were greater than or equal to 168 U· L-1. Conclusion Hepatocellular carcinoma patients with 15-minute indocyanine green clearance rate less than 15% and γ-glutamyhranspetidase concentrations less than 168 U·L-1 had good postoperative recovery of liver function. Therefore, preoperative monitoring of γ-glutamyhranspetidase level and 15- minute indocyanine green clearance rate is useful for comprehensively evaluating the compensation of liver function.